Developmental defects of the lungs

Poor lung development was first noted on scintigraphy using 99mTc-phytate in 32 children. They had all been referred for a hepatosplenic scan but the initial circulatory phase of the radiopharmaceutical was also recorded as a routine procedure. In 3 patients it revealed aplasia of an entire lung; bilateral pulmonary hypoplasia was observed in 14 of 16 patients with diaphragmatic herniae. Six patients with congenital heart enlargement showed a poorly developed ipsilateral lung; 5 of 6 patients with dextrocardia without an intracardiac defect had a larger left lung compared with the right lung; both pulmonary beds appeared equal in a patient with mesocardia.

Bilateral peritonsillar abscess: an unusual presentation

Bilateral peritonsillar abscess is uncommon. We have described a patient in whom it was misdiagnosed as bilateral hypertrophy of the tonsils. Direct palpation of the tonsils, which helped in the diagnosis in our patient, should be done routinely in patients with suspected peritonsillar abscess.

Surface vs core-tonsillar aerobic and anaerobic flora in recurrent tonsillitis

Specimens from both the surface and the core of tonsils from 23 children with recurrent tonsillitis were cultured for aerobic and anaerobic microorganisms. Mixed aerobic and anaerobic flora were obtained from all patients. The predominant anaerobic isolates were Bacteroides sp, Fusobacterium nucleatum, anaerobic Gram-positive cocci, and Eubacterium sp. The predominant aerobic isolates were alpha-hemolytic streptococci, Staphylococcus aureus, beta-hemolytic streptococci, and Haemophilus sp. beta-Lactamase production was noted in 49 isolates from 19 patients (83%). Seventy percent of the aerobic isolates were recovered in both core and surface specimens, compared with 57% of the anaerobic isolates. Ten percent of aerobes were recovered only in the core, compared with 33% of the anaerobes, and 20% of the aerobes in the surface only, compared wtih 10% of the anaerobes. These data demonstrate the discrepancies between surface and core cultures in the isolation of anaerobic bacteria, and raise the question whether surface cultures can accurately predict the presence of beta-lactamase-producing organisms or other pathogens in the recurrently infected tonsil.

Simian virus 40-associated fatal interstitial pneumonia and renal tubular necrosis in a rhesus monkey

Simian virus 40 was isolated from a young adult rhesus monkey dying of naturally acquired interstitial pneumonia and renal tubular necrosis. Light microscopic examination demonstrated basophilic intranuclear inclusions associated with the lesions in the lung and the kidney. These inclusions were positive for antigen of simian virus 40 by immunoperoxidase staining of paraffin sections of affected organs. Electron microscopy revealed characteristic papovarirus particles in these tissues. This study is the first report indicating that simian virus 40 may produce pulmonary and renal disease in its natural host.

Serological investigation of BK papovavirus infection in pregnant women and their offspring

Paired sera from 150 pregnant women and 387 umbilical cord sera were tested for BK virus (BKV) antibodies. The hemagglutination inhibition, neutralization, and indirect immunofluorescence tests were employed for the detection of antibodies. Treatment of serum with anti-gamma Fc and tests of immunoglobulin M (IgM) fractions for antibodies were utilized as required to detect and validate the presence of virus-specific IgM. The BKV antibody prevalence in the sera collected at the time of the first prenatal visit was 75% by hemagglutination inhibition and 91% by neutralization tests. A total of 95% of the women had antibodies by at least one of the three serological tests. Five of 100 women with normal pregnancies exhibited BKV activity during pregnancy as evidenced by a greater than fourfold rise in BKV hemagglutination inhibition antibody titers and acquisition of BKV-specific IgM. The antibody rise occurred in the younger women and appeared to be a result of reactivation of the virus rather than of primary infection. Two instances of possible recent BKV infections were identified. BKV-specific IgM was not detected in any of the 387 umbilical cord sera which included three specimens from infants born to mothers with definite or probable BKV activity during pregnancy and 50 specimens with IgM levels of > 20 mg/100 ml. The results indicate that few women in the child-bearing age are nonimmune to BKV and that, although reactivation of infection occurs in pregnancy, congenital transmission of the virus either does not occur or is rare.

Immunologic relatedness of papillomaviruses from different species

An antiserum prepared by immunization of a rabbit with sodium dodecyl sulfate-disrupted virions from a pool of plantar warts was cross-reactive with virus-positive papillomas of other animal species by both indirect immunofluorescence tests on frozen sections of wart tissues and peroxidase-antiperoxidase tests of sections of Formalin-fixed tissues. The antiserum stained plantar warts, common warts, and skin lesions of epidermodysplasia verruciformis, all from humans; bovine fibropapilloma, experimentally produced with bovine types 1 and 2; and transmissible canine oral papillomas. The staining was localized to nuclei of the upper granular layers of the peithelium and was similar in distribution to the pattern produced by antiserum specifically prepared against that papillomavirus. The antiserum did not stain virus-negative warts, or cells infected with simlan virus 40, human polyomavirus BK, and murine polyomavirus. These data suggested that papillomaviruses share a common internal antigen unrelated to a similar antigen described previously for the polyomaviruses (which include simian virus 40 and polyomavirus subgroups).

Wilms tumor in adolescence

A review of the literature reveals that Wilms tumor is rare in adolescence. At the time of diagnosis 78 per cent of children are less than 5 years old. Of 17 cases of Wilms tumor seen at the Ontario Cancer Foundation Clinic in Kingston from 1973 to 1975, 3 children were between 16 and 17 years old. Of 316 cases registered in Ontario with the Ontario Cancer Treatment and Research Foundation only 5 were in the 15 to 19-year age group. The possibility of Wilms tumor in patients beyond the usual age group is not considered as a differential diagnosis because of its relative rarity. Patients may present with features suggestive of neuroblastoma, renal cell carcinoma, hydronephrosis, cholecystitis, appendicitis and twisted ovarian cyst as seen in our 3 patients. In comparison, a review of 84 reported cases of renal cell carcinoma in children from 1934 to 1974 showed 5 cases in the 15 to 18-year age group.

Correlation of aspirin excretion with parameters from different dissolution methods

The cumulative urinary excretion of four different aspirin products (two tablets, a capsule, and a timed-release tablet) was determined in a crossover study using five subjects. Comparison of in vivo results showed a significant difference in cumulative urinary excretion levels at only 1 hr. The excretion from the two regular tablets was significantly different from the timed-release tablet, but the capsule showed no significant difference from the other three products. Each product was tested in the USP, Levy beaker, and the regular and large magnetic basket dissolution apparatus. Analysis of variance of the in vitro results showed a significant difference between the aspirin products and the dissolution methods at selected times. In vitro comparison with in vivo results for the four products showed that a regression analysis can be used to determined which dissolution methods produce a significant correlation with urinary excretion.

Dumbbell neurilemoma simulating lumbar disk disease

The beneficial response to a nonsurgical program for lumbar disk disease in a 56-year-old woman seemed to obviate invasive procedures. Fourteen months later, the previous symptoms and findings recurred. A myelogram showed a block at T12-L1 and a small herniated disk at L4-L5. A neurilemoma was removed. The patient is well 4 years later.

Hematologic changes in a patient with Hodgkin's disease in relapse

A patient with Hodgkin's disease also had anemia, hypochromia, and thrombocytosis, which were clues to an otherwise silent relapse. These features were corrected following chemotherapy. Repeated lymphangiography is shown to be of value in diagnosis.

Fibrogenesis imperfecta ossium

The case history, clinical course and laboratory findings in a 66-year-old woman with fibrogenesis imperfecta ossium are reported, the sixth case in the literature. The condition is characterized clinically by intractable skeletal pain and progressive immobility. Though serum alkaline phosphatase has been raised in all patients, there are no specific haematological or biochemical findings. The radiological features of coarse and dense trabecular pattern with symmetrical and diffuse involvement of all bones without expansion or change of shape, together with periosteal reactions and soft tissue calcification are characteristic. The macroscopic appearance of bone shows large areas of opaque white and brittle trabeculae. The histological findings mimic those of osteomalacia unless examined under polarized light which shows the loss of normal birefringence. On electron microscopy the normal lamellar pattern made up of orientated collagen fibrils all about 80 nm diameter is replaced by a random tangled pattern of much thinner irregularly curved fibrils, some as thin as 5nm. The condition appears to be acquired, leading to erosion of the normal skeleton and replacement with an abnormal fibre deficient matrix. There is no definitive therapy at present.

Thanatophoric dwarfism

A review of the radiographs of children previously classified as achondroplasiacs revealed six thanatophoric dwarfs. The main radiological differentiating features were the greater degree of shortening of the long bones, including the fibula, the curvature of the femora, the very small size of the thorax and, particularly, the very narrow ossified elements of the vertebral bodies. Perhaps the most important aspect of differential diagnosis lies in recognition in utero. The reported association with clover-leaf deformity of the skull in sibs provides the strongest evidence for genetic differentiation from classical achondroplasia. More evidence might be obtained by a widespread search through hospital radiological museums.